AHIP 2023 Module 4 Graded A+

AHIP 2023 Module 4 Graded A+ Question 1: An employer has provided you with a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected. What should you do? Answer: You may go ahead and call them. Question 2: Winthrop Brokerage wants to place an advertisement in the local newspaper. What obligation(s) do they have regarding the advertisement? Answer: Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval because it does not include information about the plans' benefits structures, cost-sharing, or information about measures or ranking standards. Question 3: BestCare Health Plan receives a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should they take in response? Answer: BestCare should cooperate with the state and supply requested information. Question 4: During a sales presentation for a Medicare Advantage plan with a 5-star rating in customer service and care coordination, what statement would be best to say to Ms. Daley? Answer: The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4-stars. Question 5: To comply with requirements for marketing Medicare Advantage and Part D plans, what must you do when contacting potential clients? Answer: You will have to avoid calling any potential client unless he or she initiates contact with you and specifically asks that you give him or her a call. Question 6: When making an appointment to discuss Medicare Advantage (MA) and Part D plans, what types of insurance can you present during the MA and Part D marketing appointment? Answer: You can present only health care related lines of business but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission. Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her? I. Commissions II. Bonuses III. Mileage reimbursement IV. Awards I, II and IV only Your colleague works at a third-party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells. What could you say to her? You could tell her she is wrong, and that only agents selling employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? You may provide gifts or prizes to all potential enrollees during an event that does not exceed $15 in retail value. Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state laws are preempted concerning the marketing of Medicare health plans, he doesn't have much to worry about. What might you, as his colleague, advise him concerning the type of scrutiny he will be under? Organizations sponsoring Medicare health plans are responsible for the behavior of their contracted representatives and will be conducting monitoring activities to ensure compliance with all applicable federal law and guidance and plan policies. Furthermore, state agent licensure laws are not preempted and he must abide by their requirements. Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do? Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th. You are meeting with Mrs. Hall in her home. On her scope of appointment form, she asked to discuss Medicare Advantage plans. During the meeting, she asks to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so it is important for her to make a decision before she leaves. What must happen before that additional discussion can take place? Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as long as she signs a new scope of appointment form first, indicating that she wants to discuss the Part D plan. Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to: